CARE HOMES FOR OLDER PEOPLE
The Spinney 16 College Road Upholland Wigan Lancashire WN8 0PY Lead Inspector
Anne Taylor Unannounced Inspection 09:30 30th June 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Spinney Address 16 College Road Upholland Wigan Lancashire WN8 0PY 01695 632771 01695 625599 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bondcare (Spinney) Ltd Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (3) of places The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 35 service users to include: Up to 35 service users in the category of OP (Old Age not falling within any other category). Up to 3 service users in the category of PD (Physical Disability). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 24/11/05 Brief Description of the Service: The Spinney is a thirty-five bedded care home providing nursing and personal care. Accommodation is over three floors, which can be accessed by a lift. Thirty-one rooms are single, six of which have en-suite facilities. Two shared rooms are also available. Lounges are provided on the ground and first floor. The ground floor lounge is large and spacious. The first floor lounge is smaller, but comfortable and furnished nicely. There is a dining room on the ground floor. There is a Service Users Guide that is given to all prospective residents; this is written information that tells you about the care service that is offered, who the owners, manager and staff are and what the resident can expect if he or she decides to live at the home. This information can be found in the reception of the home. A trained nurse is on duty at all times. The home is furnished to a satisfactory standard, and has a friendly ambiance. The most recent inspection report is available in the reception area of the home.
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 5 There are parking facilities to the front of the home. At the time of this visit, (30/6/06) the information given to the Commission showed that the fees for care at the home are from £300. 11 to £492. 50 per week, with added expenses for hairdressing, chiropody and newspapers. Bond Care (Spinney) Ltd, a private company own The Spinney nursing home. The Regional Manager is Mr Paul Newman and the home manager is Wendy Jo Martin. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit, which means that the manager, staff and residents did not know it was taking place until the inspector arrived. The visit covered a full day and was carried out by inspector Christine Marshall. A tour of the home was undertaken and included bedrooms, lounges and dining areas, toilets and bathrooms. The day was spent looking around the home, speaking to residents, relatives and staff and looking at administration records. All areas of the home were clean, hygienic and adequately furnished: The manager completed a pre-inspection questionnaire before this key inspection visit, which gave good information about the operational management of the home; comment cards were sent to the home for residents, relatives and visiting professionals to fill in, however few were returned. Those that were, showed that they were happy with the care at The Spinney. Discussions took place with the registered manager, trained nurses and members of the care staff: All were friendly, welcoming and co-operative throughout the visit. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 7 What the service does well: What has improved since the last inspection?
The manager has worked extremely hard since her appointment, to improve and implement the systems at the home, so that the residents have a good quality of care. An up to date statement of purpose has been produced and made available to current and prospective residents. The format is one of a corporate design, but does give all the information that is required for prospective residents and their relatives to make an informed decsiion about entering thehome. The service users guide is more user friendly and gives pictures and symbols to help the reader. Pre-admission assessments are undertaken prior to any resident entering at the home and this makes sure that the right package of care is given to each individual. Residents or a representative are invited to be involved in the assessement. A system for reviewing and improving the quality of care has been implemented, and this helps to ensure that care practices are monitored.
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 8 The medication policies and procedures have been reviewed and implemented, providing a safe system of giving tablets and medicines to the residents. Homely remedies procedures have been discontinued and only prescribed medications are given to the residents. The medication records are now all accurate and up-to-date, making sure that the residents are given the right tablets and medicines, and that all nurses sign the records properly. Arrangements have been made to ensure food is transported safely and is hot when it reaches residents. Non-slip trays and insulated plate covers are now provided for any food that is being served anywhere other than the dining room. External grounds are now suitable and safe for use by residents in that the pathway around the home has been re-surfaced. Pipe work and radiators throughout the home have been guarded or have guaranteed low surface temperatures. The home is now managing the control of legionella, and certificates were in place to confirm this. There is now an activities coordinator, who works 20 hours a week to help to provide a good programme of social activities for the residents. A written record is now kept of all items brought into the home by residents, making sure that there are no lost items of clothing or personal belongings. Complaint records now include details of the complaint, the investigation, outcome and any action taken in response to the complaint. The homes adult abuse procedure now includes contact details for relevant authorities, through the No Secrets in Lancashire booklet. A training plan is now in place for all staff and a matrix has been developed so that the manager can see at a glance her staff’s training progress. Written confirmation is now in place, confirming that the elecrical installation system is of a satisctory standard and the work highlighted on the last certificate has been completed; this makes sure that the residents are living n a safe environment. What they could do better:
After the initial pre-admission assessment, prospective residents still do not receive written confirmation that the home is able to meet their needs. This
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 9 would confirm that there is an agreed package of care between the home and the person entering it. Written plans of care were in place, however these still need to be assembled in a clear format so that the needs of the residents can be clearly recorded and monitored. The home still had less than 50 of care staff trained to NVQ level 2 or above. However, a number of carers are now enrolled on the training programme, which should bring the number up to the 50 on completion. Not all of the necessary checks were obtained for staff prior to the start of employment. This must be addressed fot the safety and protetion of the resident living at the home. The lift is remains out of commission and this is due to be completed, tested and functioning by the 14th July 2006. This needs to be in use as a matter of urgency so that residents can regain full access of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering The Spinney is supplied with enough information to help them make that decision. The home also gathers enough information about that person to ensure that their needs can be met. This means that people can make their choices and receive the care they require. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is a set of written information that tells you about the care service that is offered, who the manager and staff are, and what the resident can expect if he or she decides to live at the home. The Statement of Purpose is fairly complex and relates to the organisation’s quality system. The Service Users Guide is quite clear and includes pictures and symbols to help the reader.
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 12 The current information is available in the reception of the home. A number of staff said that knew about the Service Users Guide and Statement of Purpose, and some were able to briefly describe the provision of care that they were giving to the residents. Contracts of care were in place and signed by either the resident or their advocates. This means that residents know what to expect from the home and what is expected of them. Pre-amission assessments were looked at and were completed satisfactorily, showing that the residentss is fully assessed for their care needs before they enter the home. The home needs to confirm in writing that they can provide the care that is need by each new resident. There is an open-door visiting policy and every prospective resident and their relatives are welcomed on a visit to the home prior to making any decisions. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are met and people are treated with dignity and respect at this home. Residents are supported and protected in their daily lives. EVIDENCE: Care plans are written records that describe the care that is given to each resident. These were reviewed and gave information about the care that was being given. Care staff said that they knew about the care plans and that these generally reflected the care that they gave to each person. Generally the care plans were rather muddled and not easy to follow; the manager is in the process of re-assembling the information in each plan so that the care can be easily identified, recorded and monitored. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 14 Health care opportunities are offered to all residents and there are records of GP, chiropody and physiotherapy visits. The medication system at the home has previously had some problems, and these have now been cleared up. Trained nurses give out all medicines and records and systems were satisfactory. Policies and procedures are in place and a clinical waste agent is contracted for the disposal of unused medication. Equality of choice is evident in that any resident who wishes, and who is assessed as able, is given the facility to look after and take responsibility for their own medicines. The residents were treated with respect, privacy and dignity, and a good interaction was noted between the staff and the residents. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported so as to promote the quality of their daily lives. EVIDENCE: There is a dedicated activities coordinator who plans activities in line with individual residents’ needs and wishes. The coordinator gains information about residents’ likes and dislikes and previous pastimes and hobbies, before agreeing any programme of activity with that person. The activities that were available on a regular basis included visiting musicians, regular residents’ meetings, quizzes and bingo and relaxation sessions. On the day on the inspection it was a resident’s birthday and the visiting musician, playing the ukulele, was enjoyed by all. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 16 There are satisfactory mealtime routines for all of the residents at this home, with good assistance from the staff. All the residents who were able said that they were happy with the quality and variety of meals available at the home; they also said that snacks and drinks were available throughout the day. The monthly menus show a basic choice of food. There were nutritional assessments in place for all of the residents and a variety of meals were served, such as soft, pureed and diabetic diets. The kitchen was in need of a base clean to all units, fixtures and floor. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies, procedures and practice make sure that residents are supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and staff said that they were aware of these. A small number of residents confirmed that they knew about the complaints policy and had no complaints to offer. The complaints procedure for the home is displayed in the entrance and is included in the Service Users Guide. Training files showed that the majority of staff have had abuse awareness training during induction. Three carers said that they understood abuse awareness and had would know what to do if they had any concerns. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are provided with a comfortable, clean and hygienic environment and bedrooms are personalised. This means that residents feel at home with their belongings around them. However acces to all areas of the home is restricted. EVIDENCE: The majority of these standards are complied with and generally the quality outcome would have been good; however the passenger lift remains out of service and the residents are unable to fully access all parts of the home. This may also compromise the safety of those residents who have bedrooms on the first floor. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 19 A tour of the home showed that with the exception of the lift areas, the general environment was good; furnishings were comfortable and some aids and adaptations were in place to help with the residents’ toilet and bathing needs. Bedrooms were personalised and comfortable and three residents were able to say that they were happy with their room. Bedroom 8 has a veranda and a risk assessment for this should be undertaken. Policies are in place for the prevention of any cross infection. Some bins in bathrooms and sluices were without lids and the manager is in the process of having these replaced. The laundry area was clean, but cluttered with black plastic bags of laundry. The back wall is in need of cleaning and painting. The manager gave assurances that she would be visiting the laundry area to address this issue. An ongoing refurbishment programme is in place to maintain the environment, furnishings and fittings. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents care needs are met through satisfactory levels of staff, however not all have the appropriate qualifications and experience necessary for the delivery of a good care service, and not all have full recruitment checks. EVIDENCE: Staffing levels appeared to be satisfactory and in line with the assessed needs of the people living at the home. Staff said that they felt that there was enough staff on duty to take care of the residents, and residents themselves said that they were able to get help from staff without waiting for long periods. There are currently 30 of carers with the National Vocational Qualification (NVQ). A programme of training has been developed and when the carers who are currently enrolled on the course have completed, there will be 50 of the care staff trained to at least level two. This should promote good care for the residents because staff will be trained and competent to a satisfactory level. The staff recruitment files were looked at and not all of these contained the records required in Schedule 2 of the Care Homes Regulation 2001 (amended 2003). Some references had not been received for staff prior to employing
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 21 them at the home. Prospective staff must be fully vetted and checked, ensuring the safety and protection of the residents living at the home. Staff training files showed that there is an induction and training programme in place; the manager has developed a training matrix whereby she can see at a glance the progress of each members of staff’s training achievements and training needs. Three carers on duty said that they had been given full training in all of the basic care practices. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by an experienced manager and there are quality systems in place to make sure that they are protected; however there are isues with the acces and safety of residents because there is no working passenger lift in place at present. EVIDENCE: The manager is a Registered Nurse and is experienced in managing nursing environments overseas. However to enhance her skills, she is undertaking the Registered Managers Award (RMA) training, in line with the CSCI requirements
The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 23 and guidelines. She is in the process of application for registration with the Commission for Social Care Inspection and this is due for completion within the next few weeks. The residents said that she was friendly and approachable and often seen around the home. One resident said “The manager is really good.” A visitng relative said “The home has imporved dramatically since the new manager came, I am very happy about the care here.” The Investors in People (IIP) quality monitoring system is in place and this is due for renewal this year. The manager undertakes regular quality audits, including care plans, medications, training, personnel files, property for risk and equipment. A recent annual survey was done and the results of this are going to be posted on the home’s noticeboard so that everyone who has been involved can see the outcomes and actions. There are regular staff and resident meetings and staff confirmed that they had meetings. The manager gave assurances that all records of residents personal monies are recorded, checked and reciepts saved. The manager was aware of the responsibilities of maintaining all health and safety certificates of service for fire, equipment, electric, gas and nurse call systems; however the passenger lift remains out of action and this causes concern for the access and safety of the resdients who are immobile and who have rooms on the first floor. The lift is due to be re-commissioned and functional by 14th July 2006. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. OP29 19 Schedule 2 13 13 The registered person must ensure that all necessary checks are obtained for staff prior to the start of employment. Residents must have access to all parts of the home via ramps and passenger lifts. The passenger lift must be in place and fully functional for the health and safety of the residents. 14/07/06 2. 3. OP19 OP22 OP38 14/07/06 14/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Residents should receive written confirmation that the home is able to meet their needs.
DS0000039828.V287684.R01.S.doc Version 5.1 Page 26 The Spinney 2. 3. 4. 5. 6. 7. OP7 OP15 OP26 OP28 OP31 OP38 A written plan of care that clearly identifies needs and how the home will meet those needs should be in place for all residents. The kitchen fixtures, units and floor should be given a deep clean to promote health and hygiene. The kitchen should have the fixtures, units and floor, base cleaned Fifty per cent of care staff should be trained to NVQ level 2 or above. The manager should complete the Registered Managers Award. A risk assessment should be undertaken in respect of the veranda in room 8, for the residents’ safety. The Spinney DS0000039828.V287684.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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